What is a thyroid nodule
A thyroid nodule is a nodular lesion in the thyroid tissue.
Many thyroid disorders can cause thyroid nodules, including hyperthyroidism and Hashimoto’s thyroiditis in the endocrine category, and nodular goiter, thyroid adenoma, and thyroid cancer in the surgical category.
Classification of thyroid nodules
Based on ultrasound findings, thyroid nodules can be classified as single or multiple nodules, and based on isotope findings, thyroid nodules can be classified as hot, cool, or cold nodules. Previously, it was thought that single or cold thyroid nodules were more likely to be malignant, while multiple nodules were more likely to be benign, but with the increasing understanding of thyroid disease, it is now found that this understanding is biased and should be analyzed on a case-by-case basis.
Since thyroid nodules have a certain rate of malignancy, in principle, surgery should be considered for thyroid nodules, but the decision must be based on the size of the nodule, ultrasound and the results of fine needle aspiration of the nodule.
Ten common questions about thyroid nodules
There are many patients with thyroid nodules who do not know much about their disease and often seek treatment in a hurry, which not only increases the cost of treatment, but also delays the condition.
We have purposely summarized the ten most frequently asked questions from patients in the clinic, and the answers are as follows.
1. I usually eat iodized salt, how come I still have thyroid nodules?
It is true that most thyroid nodules develop due to iodine deficiency, but a long-term diet high in iodine can also increase the level of thyroid hormones in the body, thus stimulating thyroid tissue hyperplasia and nodules. Because iodine is already added to our salt, long-term consumption of seafood with high iodine content, such as kelp, can also easily cause thyroid nodules.
2. Is it better to operate or not to operate for thyroid nodules?
Generally speaking, surgery is recommended for thyroid nodules over 1 cm in diameter, especially for those over 1 or 5 cm. For nodules between 1 and 1.5 cm in diameter, thyroxine preparations can be tried for 6-9 months, and if the nodule shrinks or does not continue to grow, surgery can be suspended. However, nodules with sand-like calcifications found by ultrasound, or nodules with papillary hyperplasia or suspected cancer found by puncture need to be operated regardless of size.
3.Why do benign thyroid nodules easily recur after surgery?
If the surgical excision is not complete, there is a high possibility of residual hyperplastic thyroid tissue and microscopic nodules, and postoperative thyroxine suppression therapy has limited effect on the residual lesions, so the recurrence rate is high after surgery. Nowadays, total/near-total thyroidectomy is usually performed abroad, which completely avoids postoperative recurrence and the risk and pain of reoperation for patients whose thyroid cancer is diagnosed only after surgery. In recent years, total/proximal total thyroidectomy has also been performed for bilateral diffuse nodular goiter with excellent results after obtaining the patient’s consent.
4. Why is it more difficult to speak after thyroid nodule surgery?
This is mainly because the thyroid nodule is often dissected during surgery to avoid damaging the recurrent laryngeal nerve, which may cause edema of the recurrent laryngeal nerve or affect its blood supply, so that there will be more straining to speak. However, this phenomenon will gradually disappear about 3 months after surgery as the edema subsides and the blood supply is restored.
5. Why do my hands and feet go numb after thyroid nodule surgery?
This is mainly due to the fact that certain blood vessels had to be cut during the surgery for thyroid nodules, causing the blood supply to the parathyroid glands to be affected. When numbness in hands and feet occurs, it can often be relieved by taking appropriate calcium supplements such as Calcium D tablets, and will gradually disappear about 2 months after surgery.
6. Why is the incision swollen and hard after thyroid nodule surgery?
This is actually due to the normal edema reaction of the incision after surgery. Thyroid nodule surgery involves extensive separation of the skin flaps above and below the incision, which can cause edema in the tissues surrounding the incision. Especially in middle-aged and elderly women, the skin is loose and there is more fatty tissue, so the incision is easily edematous. Generally, the incision will gradually return to smoothness within 2 months after surgery.
7. Why is there a pulling sensation or even coughing when swallowing after thyroid surgery?
This is related to the normal scar contraction reaction after thyroid nodule surgery. This is because, although there is only a line like scar on the neck after thyroid nodule surgery, the actual surgical incision is much larger than this scar. This wound, like the incision in the neck, requires a normal scar response to recover. The scar reaction process will contract and pull the trachea near the trauma, causing a pulling sensation when swallowing and even irritating the trachea to trigger a cough.
8.Does taking thyroxine preparations after surgery have any effect on my body?
The main side effects of taking thyroxine preparations are headache, palpitations and high blood pressure. It is necessary to check thyroid function regularly to avoid overdose and drug-related hyperthyroidism. As long as the dosage is appropriate, long-term use of thyroxine preparations will not cause adverse effects on the body.
9.What are the precautions for taking thyroxine preparations?
It is best to take thyroxine preparations in the early morning after waking up on an empty stomach, and eat breakfast about half an hour after taking the drug, so that the side effects of the drug can be minimized and the efficacy is best. Avoid taking it together with drugs for stomach problems.
10.What are the requirements for diet after thyroid nodule surgery?
To reduce recurrence after thyroid nodule surgery, you should eat less seafood and avoid iodine-rich foods, such as kelp, shrimp and nori.